TY - JOUR
T1 - International Multicenter Study of Clinical Outcomes of Sinonasal Melanoma Shows Survival Benefit for Patients Treated with Immune Checkpoint Inhibitors and Potential Improvements to the Current TNM Staging System
AU - Lechner, Matt
AU - Takahashi, Yoko
AU - Turri-Zanoni, Mario
AU - Ferrari, Marco
AU - Liu, Jacklyn
AU - Counsell, Nicholas
AU - Mattavelli, Davide
AU - Rampinelli, Vittorio
AU - Vermi, William
AU - Lombardi, Davide
AU - Saade, Rami
AU - Park, Ki Wan
AU - Schartinger, Volker H.
AU - Franchi, Alessandro
AU - Facco, Carla
AU - Sessa, Fausto
AU - Battocchio, Simonetta
AU - Fenton, Tim R.
AU - Vaz, Francis M.
AU - O'Flynn, Paul
AU - Howard, David
AU - Stimpson, Paul
AU - Wang, Simon
AU - Hannan, S. Alam
AU - Unadkat, Samit
AU - Hughes, Jonathan
AU - Dwivedi, Raghav
AU - Forde, Cillian T.
AU - Randhawa, Premjit
AU - Gane, Simon
AU - Joseph, Jonathan
AU - Andrews, Peter J.
AU - Dave, Manas
AU - Fleming, Jason C.
AU - Thomson, David
AU - Zhu, Tianyu
AU - Teschendorff, Andrew
AU - Royle, Gary
AU - Steele, Christopher
AU - Jimenez, Joaquin E.
AU - Laco, Jan
AU - Wang, Eric W.
AU - Snyderman, Carl
AU - Lacy, Peter D.
AU - Woods, Robbie
AU - O'Neill, James P.
AU - Saraswathula, Anirudh
AU - Kaur, Raman Preet
AU - Zhao, Tianna
AU - Ramanathan, Murugappan
AU - Gallia, Gary L.
AU - London, Nyall R.
AU - Le, Quynh Thu
AU - West, Robert B.
AU - Patel, Zara M.
AU - Nayak, Jayakar V.
AU - Hwang, Peter H.
AU - Hermsen, Mario
AU - Llorente, Jose
AU - Facchetti, Fabio
AU - Nicolai, Piero
AU - Bossi, Paolo
AU - Castelnuovo, Paolo
AU - Jay, Amrita
AU - Carnell, Dawn
AU - Forster, Martin D.
AU - Bell, Diana M.
AU - Lund, Valerie J.
AU - Hanna, Ehab Y.
N1 - Publisher Copyright:
© 2022 Thieme Medical Publishers, Inc.. All rights reserved.
PY - 2022/1/22
Y1 - 2022/1/22
N2 - Objectives Sinonasal mucosal melanoma (SNMM) is an extremely rare and challenging sinonasal malignancy with a poor prognosis. Standard treatment involves complete surgical resection, but the role of adjuvant therapy remains unclear. Crucially, our understanding of its clinical presentation, course, and optimal treatment remains limited, and few advancements in improving its management have been made in the recent past. Methods We conducted an international multicenter retrospective analysis of 505 SNMM cases from 11 institutions across the United States, United Kingdom, Ireland, and continental Europe. Data on clinical presentation, diagnosis, treatment, and clinical outcomes were assessed. Results One-, three-, and five-year recurrence-free and overall survival were 61.4, 30.6, and 22.0%, and 77.6, 49.2, and 38.3%, respectively. Compared with disease confined to the nasal cavity, sinus involvement confers significantly worse survival; based on this, further stratifying the T3 stage was highly prognostic (p < 0.001) with implications for a potential modification to the current TNM staging system. There was a statistically significant survival benefit for patients who received adjuvant radiotherapy, compared with those who underwent surgery alone (hazard ratio [HR] = 0.74, 95% confidence interval [CI]: 0.57-0.96, p = 0.021). Immune checkpoint blockade for the management of recurrent or persistent disease, with or without distant metastasis, conferred longer survival (HR = 0.50, 95% CI: 0.25-1.00, p = 0.036). Conclusions We present findings from the largest cohort of SNMM reported to date. We demonstrate the potential utility of further stratifying the T3 stage by sinus involvement and present promising data on the benefit of immune checkpoint inhibitors for recurrent, persistent, or metastatic disease with implications for future clinical trials in this field.
AB - Objectives Sinonasal mucosal melanoma (SNMM) is an extremely rare and challenging sinonasal malignancy with a poor prognosis. Standard treatment involves complete surgical resection, but the role of adjuvant therapy remains unclear. Crucially, our understanding of its clinical presentation, course, and optimal treatment remains limited, and few advancements in improving its management have been made in the recent past. Methods We conducted an international multicenter retrospective analysis of 505 SNMM cases from 11 institutions across the United States, United Kingdom, Ireland, and continental Europe. Data on clinical presentation, diagnosis, treatment, and clinical outcomes were assessed. Results One-, three-, and five-year recurrence-free and overall survival were 61.4, 30.6, and 22.0%, and 77.6, 49.2, and 38.3%, respectively. Compared with disease confined to the nasal cavity, sinus involvement confers significantly worse survival; based on this, further stratifying the T3 stage was highly prognostic (p < 0.001) with implications for a potential modification to the current TNM staging system. There was a statistically significant survival benefit for patients who received adjuvant radiotherapy, compared with those who underwent surgery alone (hazard ratio [HR] = 0.74, 95% confidence interval [CI]: 0.57-0.96, p = 0.021). Immune checkpoint blockade for the management of recurrent or persistent disease, with or without distant metastasis, conferred longer survival (HR = 0.50, 95% CI: 0.25-1.00, p = 0.036). Conclusions We present findings from the largest cohort of SNMM reported to date. We demonstrate the potential utility of further stratifying the T3 stage by sinus involvement and present promising data on the benefit of immune checkpoint inhibitors for recurrent, persistent, or metastatic disease with implications for future clinical trials in this field.
KW - TNM
KW - immune checkpoint blockade
KW - immune checkpoint inhibitors ipilimumab
KW - immunotherapy
KW - sinonasal mucosal melanoma
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U2 - 10.1055/s-0042-1750178
DO - 10.1055/s-0042-1750178
M3 - Article
C2 - 37405239
AN - SCOPUS:85134744413
SN - 2193-634X
VL - 84
SP - 307
EP - 319
JO - Journal of Neurological Surgery, Part B: Skull Base
JF - Journal of Neurological Surgery, Part B: Skull Base
IS - 4
ER -